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SUNY Downstate Health Sciences University

University Hospital of Brooklyn

Health Information Management Department:
Medical Records Frequently Asked Questions

To request your medical records please use either of the following:

What is a medical record?

The terms medical record, health record, and medical chart are used interchangeably to describe the systematic documentation of a single patient's medical history and care across time within one particular health care provider's jurisdiction.

The medical record includes a variety of types of "notes" entered over time by health care professionals, recording observations and administration of drugs and therapies, orders for the administration of drugs and therapies, test results, x-rays, reports, etc. The maintenance of complete and accurate medical records is a requirement of health care providers and is generally enforced as a licensing or certification prerequisite.

Frequently Asked Questions

Please review these questions and answers, and reach out to us if you need further assistance.

What is a Valid Authorization?

The Health Insurance Portability & Accountability Act (HIPAA) sets the standard for a valid authorization to release information. The following elements must be included for a HIPAA-compliant authorization:

  • Name and date of birth
  • Statement of who is authorized to release records and who is authorized to receive records
  • Purpose of Disclosure
  • Type of information to be disclosed
  • Psychiatric record, Alcohol & Substance Abuse, or infectious diseases (i.e. HIV, Hepatitis C, TB, etc.) must be clearly marked or checked before they will be released and must be physician approved except for payment, treatment, or operations
  • Statement acknowledging the patient's right to revoke or cancel authorization
  • Statement indicating the patient’s right to refuse the release of information
  • Statement that information disclosed pursuant to the authorization may be subject to re-disclosure and is no longer protected under this authorization
  • Statement that will not condition treatment on patient providing authorization
  • An expiration date
  • Signature of patient or patient’s representative

Is there a fee to obtain my records?

No fee will be charged for records copied at the request of a health care provider (i.e. physician, nurse practitioner, nurse, etc.) or for records sent to a health care provider at the request of the patient for the purpose of continuing care. However, there is a fee charged for copies of records requested by the patient for his/ her own purposes, as well as for third party requests, including attorneys representing patients.

If you request records other than continued care, we require payment prior to the records being released. Please provide contact information on Patient Authorization for Release. A prepay invoice will be sent to the address listed on the Patient Authorization for Release form. Once payment is received, we will mail it or records can be picked up at Downstate, Health Information Management Department. Payments can be made by Credit Card, Debit Card, or Check. Please make all checks payable to “Verisma” instead of SUNY Downstate Health Sciences University. Fees for medical records are state regulated.


Photocopies: $0.39/page for first 200 pages; $0.12/page for pages 201-400; Free for >400 pages.
Electronic media / Email: Flat fee of $6.50
Mammograms: Flat fee of $6.50
Summaries/ Explanations: Dependent upon number of hours and physician hourly consult rate.
(Fees do not apply to requests for medical records in support of an application for government benefits)

What is included within a medical record and what should I request?

The following provides a brief summary of the various parts of a medical record which may help to identify information to request:

Completely fill out the form in its entirety. Include dates of service (if no dates are given, we will give the last 2 years of information) and type of information needed, for example:

  • Discharge Summary
  • History & Physical
  • Final Summary
  • Consultation
  • Emergency Room Report
  • Operative Report
  • Office Visits/Notes
  • Pathology Report
  • EKG
  • Laboratory Reports
  • X-Ray reports/films/imaging reports
  • Request a copy of your entire record

When should I expect to receive my medical records?

The goal at SUNY Downstate Health Sciences University is to complete requests within 10 to 30 days of receipt. We understand that at times extenuating circumstances do not allow for 30 days; however, we make every effort to accommodate and satisfy our patients’ needs.

Who is legally authorized to sign a Patient Authorization for Release of Information?

People who are authorized to Sign for the Release of Your Health Information:

  • Yourself (Not your Spouse)
  • A parent if the patient is under 18 years of age
  • A minor, age 14-17 years, receiving psychiatric, drug/alcohol services, or who has a child
  • Both parents and minor if the patient is age 12-17 years and receiving drug/alcohol services
  • Legal Guardian (must provide proof of guardianship)
  • Power of Attorney if patient is unable to sign. (the Power of Attorney documentation must be presented)
  • Executor/representative of estate for deceased patient and a copy of a “short form” death certificate presented. (must provide proof of Executorship)

Healthcare Power of Attorney:

  • The Patient and/or anyone who is named as a decision maker or attorney-in-fact under a healthcare power of attorney signed by the patient.

Durable Power of Attorney:

  • If there is a durable power of attorney, a pre-approval is required by the Release of Information staff.
  • If the patient is deceased, the record must be requested by the court appointed "personal representative" presenting a raised seal original certificate of appointment issued by the Probate Court.
  • An Affidavit that is completed, signed and notarized along with the original death certificate.
  • If the patient is under the age of 16, the patient’s parent may sign.
  • If you have other special circumstances, please contact the Release of Information for assistance at 718-240-1845 or 2891

How can I obtain my birth certificate?

Questions about birth certificates should be directed to the NYS Department of Health

Their web site can be found at:

Who has access to my Medical Records?

Patient medical records are confidential and shall not be released, nor the information contained therein disclosed, except in accordance with legal requirements and Downstate policies and procedures. Although the information contained within the medical record belongs to the patient, patient medical records are the property of Downstate. Patient medical records are maintained in accordance with legal, accrediting, and regulatory requirements.

Patient Bill of Rights
Notice of Patient Privacy Practices

What is a legal guardian, curator, or personal representative?

If the patient is deceased or lacks the capacity to consent, copies of patient records may be released, upon the written request to the patient's guardian, curator, or personal representative. The requester shall present proof of court appointment as guardian, curator, or personal representative. The existence of a personal representative means a person claiming to be the next of kin is not entitled to a copy of the patient record, unless the personal representative authorizes the release of the record, in writing, to the next of kin.

What identification is required to obtain a medical record?

Prior to the release of patient medical information, the requesting party must provide a valid picture ID / State ID. 
Examples: New York state Drivers License, Medicaid Card, and Passport.

Who is considered next of kin? 

If the patient is deceased, the patient's personal representative or the family member who stands in line of intestate (without a will) succession shall provide authorization.

How do I obtain my medical records?

To request your medical records, you need to complete our Patient Authorization for Release form. You may come onsite the office hours are Monday - Friday 8:00 a.m. to 5:00 p.m.,

You can download the Patient Authorization for Release form or OCA Form 960, you can send it to the mailing address below.

SUNY Downstate Health Sciences University
Release Of Information Unit (ROI) 
450 Clarkson Ave
HIM Dept. MSC #119
Brooklyn NY, 11203

To check on the status of your request, please contact us:

Phone numbers: 718-270-2891 / 718-270-1845


How do I obtain my child's medical records?

In general, the written authorization of a parent or guardian is required to release patient records of a minor.  However, if a minor is emancipated or authorized by law a consent is required from that patient to access their records. Patient records of emancipated minors and/or minors authorized by law are otherwise governed by the same rules that apply to the release of adult patient medical records.

How do I get a copy of my Radiology Film?

To obtain a copy of your X-Ray film, you must call the Radiology Department directly.

SUNY Downstate Health Sciences University: 718-270-3125

What if I need to get my medical records for continued medical care with another physician or at another health care facility?

Sending Medical Records to a Different Physician or Health Care Facility.

If you wish to have your records sent to another health care facility other than the ordering facility, you will need to complete a Patient Authorization for Release form or OCA Form 960 with the receiving health care facilities information on it as the disclosed party.